Leticia Bustamante

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

FNP17877 Issued in CA

Practice address

751 West Legion Road
Suite 102
Brawley, CA 92227

Phone

(760) 351-8696

Fax

(760) 545-0253

NPI assigned

Nov 28, 2007

Last updated

Aug 17, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Family Health Centers of San Diego IncGroup PAC ID 3476446378, 299 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Family Health Centers of San Diego, Inc

  dba Logan Heights Family Health Center

  • Federally Qualified Health Center (FQHC)
  • San Diego, CA
  • NPI 1447281936
  Medicare reassignment Care Compare group NPD
• Imperial Valley Family Care Medical Group Apc

  • General Practice Physician
  • Imperial, CA
  • NPI 1275581894
  Medicare reassignment NPD
• Family Health Centers of San Diego, Inc

  dba Escondido Physical Health and Wellness

  • Federally Qualified Health Center (FQHC)
  • Escondido, CA
  • NPI 1356178180
  NPD
• Imperial Valley Family Care Medical Group, Apc

  • Cardiac Rehabilitation Registered Nurse
  • Imperial, CA
  • NPI 1750112587
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1196208000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692230400000",
    "number": "1609058924",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "823 GATEWAY CENTER WAY",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921024541",
            "telephone_number": "619-515-2300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "751 WEST LEGION ROAD",
            "address_2": "SUITE 102",
            "city": "BRAWLEY",
            "state": "CA",
            "postal_code": "92227",
            "telephone_number": "760-351-8696",
            "fax_number": "760-545-0253"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1809 National Ave",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "92113",
            "country_code": "US",
            "telephone_number": "619-515-2300",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2391 Island Ave",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "92102",
            "country_code": "US",
            "telephone_number": "619-515-2435",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BUSTAMANTE",
        "first_name": "LETICIA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-11-28",
        "last_updated": "2023-08-17",
        "certification_date": "2023-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "FNP17877",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0066310",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC03830F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brent a. Butcher, MD, Inc.
• Riley Brown
• Jay Kenneth Paloma Buenaflor, M.D.
• Valerie Marie Buenaflor, FNP
• Arsinur Diana Burcoglu-Oral, MD
• Frederic Butler, MD
• Arlet M Calderon Guerrero
• Kimberly Calderon, NP
• Calipatria State Prison
• Jerry Call

• Nurse Practitioner in Brawley, CA
• Providers in Brawley, CA by specialty
• Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.